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RRC160057-03 Southeast Iowa Regional Medical Center (Terminated)
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Main Details
Name
Southeast Iowa Regional Medical Center
Subdivision Name
Radiation Oncology
Type
Rural Referral Center
Rural
Yes
340B ID
RRC160057-03
Medicare Provider Number
160057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/15/2015
Last Recertification Date
8/16/2021
Termination Date
Termination Reason
4/1/2022
Change of covered entity type
Contacts
Authorizing Official
Great River Health System
Jeremy Alexander, CFO
(319) 768-3280
Primary Contact
Southeast Iowa Regional Medical Center
Steve Frigo, Director, Pharmacy
(319) 768-3971
Addresses
Street Address
1315 West Agency Road
West Burlington, IA 52655
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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